Ophthalmology and Optometry Coding Alert

Question: How should I code for Botox injections to control blepharospasm?

Idaho Subscriber

Answer: For chemodenervation using Botox for blepharospasm (333.81), the uncontrollable contracting of eyelid muscles, you should select 64612 (Chemodener-vation of muscle[s]; muscle[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]), according to CPT 2004.

Medicare payers will allow reimbursement for 64612 per eye. For example, if the ophthalmologist uses Botox to treat blepharospasm with injections into the skin around one eye, you would use 64612 with modifier -LT (Left side) or -RT (Right side) on the first line of the CMS-1500 form. If he injects Botox for blepharospasm of the right and left eyelids, report 64612-50 (Bilateral procedure).

With payers other than Medicare, you should always use two lines when billing multiple procedures -- so in this case, code 64612-RT, 64612-50-LT.

The billing is done per area (right or left), not per injection. If the ophthalmologist administers more than one injection on the same side, you may still only report a single billing of 64612.

If your office is supplying the drug, don't forget to bill using HCPCS supply code J0585 (Botulinum toxin type A, per unit). In the past, Medicare reimbursed J0585 as 100 units, but for years they have reimbursed per unit. They also reimburse for any waste when a remainder of the botulinum vial has to be discarded.

Example 1: If the physician uses 50 units of the vial for injections and has to discard the remaining 50 units, you could bill for the total of 100 units. Though it is not required, most offices report the used and wasted units on two lines, so the billing matches up with the chart documentation.

Example 2: If the physician sees two patients on the same day for Botox injections and he's left with 25 units of waste in the vial, which patient should you bill the waste to? It may seem "fair" to split the waste between the patients the vial was used on, but you should only bill it to the last patient seen, since that visit is the point the unused portion became wasted.

Caution: Some claims systems only allow you to input two characters in the quantity field. (You don't want to key in 100 units and end up only getting paid for 10.) In that scenario, it is acceptable to bill 99 units on one line and 1 unit on the second line.